What Nonpsychiatrists Want From Psychiatrists: Data From Chart Review Consultation Requests in a Rural Health Care...

Area of Science:

• Psychiatry
• Health Services Research
• Digital Health

Background:

• The demand for accessible psychiatric services is increasing, especially in rural areas.
• Electronic consultation (e-consult) services offer a novel approach to psychiatric service delivery.
• The Ask-A-Doc (AAD) service was implemented in a rural healthcare system to address these needs.

Purpose of the Study:

• To characterize the utilization of the Ask-A-Doc (AAD) outpatient electronic consultation service.
• To understand the types of psychiatric inquiries non-psychiatrists submit through AAD.
• To identify the primary reasons and patient symptoms driving e-consultations.

Main Methods:

• A qualitative codebook was developed and validated with high interrater agreement (92%).
• The codebook was applied to analyze 707 free-text AAD questions submitted over 12 months.
• Data were categorized by source, provider type, reason for submission, and mentioned symptoms/diagnoses.

Main Results:

• Primary care providers submitted 95% of AAD questions, predominantly physicians (56%) and advanced practitioners (44%).
• Medication management was the most common reason for submission (90%), with psychiatric symptoms (85%) mentioned more often than diagnoses (52%).
• Anxiety and depression were the most frequently cited symptoms, while bipolar disorder, ADHD, and major depressive disorder were common diagnoses.

Conclusions:

• Non-psychiatrists value psychiatrist input for managing mental health conditions.
• The primary need is for guidance on medication management targeting specific symptoms.
• There is less demand for assistance with psychiatric diagnoses or treatment plans for specific disorders.